Guard the Gaze: A comprehensive eye care for a better solution

Janani

DNB Anaesthesia, Final year PG, Kauvery Hospital, Cantonment, Trichy

Abstract

Background

General anaesthesia obtunds the patient’s autonomic reflexes (eg, corneal reflex) and decreases tear production. Ocular symptoms and signs may have catastrophic consequences for the patient

Corneal abrasion is the most common ocular complication occurring during the peri-anesthesia period.

Preventive measures and vigilant care can help to reduce the incidence of ocular symptoms

  • Place of Audit: KMC Specialty Hospital, Cantonment.
  • Date of Audit: 01/08/2024 to 31/01/2025
  • Source of Audit: Operating room and PACU Unit, KMC Specialty Hospital, Cantonment.
  • Done by: Department of Anaesthesiology.

Introduction

Methodology

All ASA I and II patients undergoing elective surgery under General Anaesthesia

  • Demographic details of patients
  • Diagnosis and proposed surgery
  • Postoperative conjunctival redness, photophobia, FB sensation, blurred vision

Results

Totally 2 Groups

Population 1: All patients undergoing general anaesthesia had their eyes protected using passive eye closure with gauze and adhesive tape

Population

2: All patients undergoing general anaesthesia had their eyes protected using eye patches (opticlude) with ocular lubricant (Chloramphenicol 1%).

Outcomes

  • Population 1: 8 out of 356 patients had ocular symptoms and sign
  • Population 2: 3 out of 350 patients had ocular symptoms and sign.

Population 1

Population 2

Observation

  • Population 1: 2.2% of patients had ocular symptoms and sign
  • Population 2: 0.8% of patients had ocular symptoms and sign

Literature review

  1. Liyew TM, Mersha AT, Admassie BM, Arefayne NR. Risk stratification, prevention and management of perioperative corneal abrasion for non-ocular surgery: Systematic Review. Ann Med Surg (Lond). 2023 Dec 4;86(1):373-381.

Abstract

Background: A corneal abrasion is a flaw in the cornea’s epithelial surface, which is located in the front of the eye. It causes recurrent erosions, corneal inflammation, and chronic corneal defects. In a context with limited resources, the goal of this review was to provide an evidence-based procedure for perioperative risk stratification, prevention, and management of corneal abrasion during non-ocular surgery.

Results: From 8767 identified articles, two hundred articles were removed for duplication and 7720 studies were excluded, 1205 articles were retrieved and evaluated for eligibility. Finally, 24 were included in this systematic review. Advanced age, Prominent eyes, exophthalmus, ocular surface abnormalities (dry eye), expected duration of surgery (>1 h), the favourable position of the surgery, prone,Trendelenburg and lateral, risk of bleeding, surgical site of the surgery(head /neck) and diabetes mellitus were risk for corneal abrasion. The use of appropriate intervention with pharmacological and Non-pharmacological strategies minimizes the occurrence of perioperative corneal abrasion was crucial for the quality of care.

Conclusion: Preventing and managing corneal abrasion improves patients’ quality of life. However, there was insufficient evidence to draw conclusions, and high-quality trials of multimodal interventions matched to risk stratification and prevention of corneal abrasion needed to provide robust evidence to guide prevention and management of perioperative corneal abrasion.

Conclusion

Thus taping the eyes shut by placement of opticlue over the closed eyes with ocular lubricant will effectively reduce the incidence of perioperative exposure keratitis, ocular symptoms and sign.

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